Muslims with renal transplant often ask their doctors whether fasting Ramadan is safe. Scanty studies have addressed this question. This prospective study was undertaken to identify any clinical or biological changes with Muslim fasting. 22 kidney transplant patients with stable kidney functions, who were transplanted for more than one year, and voluntarily chose to fast during Ramadan in 1425 H (October-November 2004), were studied. Total of 22 subjects (10 men and 12 women) with a mean age of 47 ± 11.6 years were studied. Full clinical and biological assessment was done before during and after the month of Ramadan fasting. Medications were taken in two divided doses at sunset (time of breaking the fast) and pre dawn (before the fast). None of the patients experienced any undue fatigue, or symptoms. Body weight, blood pressure, kidney function tests, blood sugar, lipid profile, and cyclosporine levels remained stable. In conclusion it is safe for renal transplant recipients of more than one year and having stable graft function to fast during the month of Ramadan; however caution is advised for moderate to severe impaired renal function.

Fasting during Ramadan is a religious duty for all healthy adult Muslims. Though the patients are exempted, most of the Muslim with renal transplant recipients are keen to observe the fast.

In normal subjects, during fasting Ramadan, urinary volume, osmolality, pH, nitrogen, solute and electrolyte excretion remain normal.[1] Changes in serum urea and creatinine are usually small and not statistically significant,[2],[3] as well as the alterations in serum sodium and potassium.[3]

There is paucity of studies addressing this issue in kidney transplant patients. None of them show any deleterious effect on kidney functions.[4],[5],[6] We conducted a prospective study during the month of Ramadan to find out the clinical or biological changes during fasting in renal transplant patients.

Patients and Methods

Three months prior to Ramadan patients ful­-filling the study criteria were registered and given three appointments: a month prior to, during and after the month of Ramadan fas­ting. Full clinical and biological (blood tests) assessment was done in the three occasions. Inclusion criteria were: Transplanted for more than one year, with stable kidney functions, and voluntary consent to observe the fast. Ex­clusion criteria were any acute illness imme­diately prior to and during the month of fasting.

During Ramadan medications were taken at sunset and pre dawn, blood and urine samples were taken just before "Iftar" and around 12 hours after last dose of calcineurin inhibitor. Co morbid conditions like hypertension, dys­lipidemia and diabetes mellitus were found in 20, 9 and 5 patients respectively.

Unpaired 2 tail Student's t test was used and p< 0.05 was considered significant.

The study was approved by our ethics committee.

Results

All patients managed to fast the whole month of Ramadan. The fasting time during Ramadan 1425 H (2004 AD) was around 12:30 h. None of the patients had any undue clinical symp­toms or signs and no significant changes in any clinical or biological parameters during or after Ramadan, [Table 1].

Discussion

Our results are in agreement with the others,[4],[6] and indicate that fasting during the month of Ramadan is not associated with any significant adverse effect in our stable renal transplant recipients.

We did not find any significant change in patients' weight and BP during and after the fast. The renal function remained stable as re­flected by the absence of any significant diffe­rence in s. creatinine, urea and electrolytes during the period of study. No significant difference in lipid profile except triglycerides showed significant improvement during fas­ting that reversed after Ramadan.

In conclusion, it is safe for a kidney trans­plant recipient for more than one year, with stable kidney functions to fast during the Ra­madan month. Caution is however suggested for patients with significantly low esti-mated GFR who may require more frequent moni­toring of renal functions.